Insomnia is a sleeping disorder that makes it difficult for someone to fall asleep and/or stay asleep. People with insomnia will awaken unrefreshed, which may eventually cause disruption during their day. Most people need seven to eight hours of sleep per night. However, people with insomnia may get only six or fewer hours of sleep per night three or more times per week. In addition, it may take 30 or more minutes to fall asleep at night.

Insomnia can be classified as acute or chronic. Acute insomnia is generally considered short term, lasting one night to a few weeks. Chronic insomnia occurs at least three times per week for one month or longer. Insomnia may affect a person’s energy level, mood, health, work performance, and quality of life. Insomnia is more common in older people due to a change in sleep patterns, a change in activity, a change in health, or an increase in medication usage.

Symptoms
Some common symptoms of insomnia include difficulty falling asleep, waking up often during the night, trouble getting back to sleep, waking up too early, daytime fatigue or sleepiness, irritability, depression, anxiety, difficulty focusing on tasks, increased errors or accidents, and tension headache.

Common Causes
Some common causes of insomnia include stress, anxiety, depression, medications, caffeine, nicotine, alcohol, a change in environment or work schedule, and poor sleep habits.

ICD-9-CM Code Assignments
Common insomnia disorders include the following:

• adjustment insomnia (307.41);

• psychophysiological insomnia (307.42);

• drug-induced sleep disorders (292.85);

• alcohol-induced sleep disorders (291.82); and

• organic insomnia (subcategory 327.0).

Insomnia unspecified is classified to code 780.52, and insomnia with sleep apnea goes to code 780.51.

Insomnia may be described as primary or secondary. Primary insomnia (307.42) is sleeping problems not directly associated with any other health condition or problem. Secondary insomnia is a sleeping problem due to another condition.

Code 327.01 is assigned for insomnia due to a medical condition classified elsewhere, and code 327.02 is assigned for insomnia due to a mental disorder. In both of these instances, the underlying condition will be coded and sequenced first. Some common conditions that may cause insomnia include Alzheimer’s disease, arthritis, asthma, cancer, depression, gastroesophageal reflux disease, heartburn, heart failure, lung disease, Parkinson’s disease, and stroke.

Diagnosis
To aid in the diagnosis of insomnia, a physician may have the patient complete a questionnaire to obtain information on wake-sleep patterns in addition to a complete medical history and physical examination. The physician may have the patient keep a sleep diary for several weeks to collect more information. In addition, the physician may order blood tests to rule out other conditions that could cause the insomnia.

Treatment
No treatment may be necessary for acute insomnia. Some insomnia may be treated and resolved by creating good sleep habits, which include the following:

• keeping consistent bedtime and wake-up times;

• eliminating afternoon naps;

• avoiding caffeine, nicotine, alcohol, and heavy meals late in the day;

• exercising regularly but not close to bedtime; and

• making the bedroom “sleep friendly,” such as dark, quiet, and an appropriate temperature.

The physician may prescribe sleeping pills for a limited time.

Coding and sequencing for insomnia are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.

ICD-10-CM Coding for Insomnia
Codes for insomnia are mainly located in two chapters in ICD-10-CM: Chapter 6, Diseases of the Nervous System (G00 to G99) and Chapter 5, Mental and Behavioral Disorders (F01 to F99).

Insomnia without further specification will default to code G47.00, Insomnia, unspecified, which also includes organic insomnia. If insomnia is due to a medical condition, assign code G47.01 first followed by an additional code for the associated medical condition. Other specified insomnia goes to code G47.09.

Insomnia is classified in two areas in the Mental and Behavioral Disorders chapter in ICD-10-CM. Subcategory F51.0 includes insomnia not due to a substance or known physiological condition (nonorganic insomnia) and includes the following:

• primary insomnia (F51.01) includes idiopathic insomnia;

• adjustment insomnia (F51.02);

• paradoxical insomnia (F51.03);

• psychophysiologic insomnia (F51.04);

• insomnia due to other mental disorders (F51.05), code also associated mental disorder; and

• other insomnia not due to a substance or known physiological condition (F51.09).
Alcohol or drug related insomnia is classified depending on whether the substance is documented as abuse, dependence, or use (see chart below for more information).